Guidance for nursing and midwifery on ‘What Good Looks Like’

Since the publication of the What Good Looks Like (WGLL) for Nursing Guidance in 2022, we have supported organisations with the adoption of each of the success measures’ imperatives and gathered feedback on their implementation journey.

As part of our stakeholder engagement we received extensive feedback from midwifery leaders on the relevance and usability of the principles for the profession’s practice. In response to this feedback and the change in landscape since its original publication we established a task and finish group made up of nursing and midwifery professionals in Autumn 2023.

This group were given the remit to review the guidance to ensure its content is up to date and in line with our current landscape and have also looked at how the success measures can be applied to midwifery.

Who is this guidance for?

Guidance for nursing and midwifery on WGLL is directed at board level nurse and midwife (N&M) leaders who have accountability for digital transformation in either their Integrated Care System (ICS) or organisation. In this guidance we refer to these roles as digital leaders which are in direct reference to individuals who are accountable and able to influence the digital transformation agenda at organisation level or at an ICS for both professions.

For midwifery, it is noted that system wide partnerships and the maternity strategy within the ICS will also be supported by the Local Maternity and Neonatal System (LMNS).

WGLL success measures in nursing and midwifery

Success measure 1 - Well led

Integrated care systems (ICSs) span organisational boundaries and have system-wide leadership that represent the diversity of the workforce. Your ICS and within it, the LMNS set the system-wide strategy for digitally enabled care.

What good looks like for ICSs:

• There is a nursing and midwifery leader with accountability for both the nursing and midwifery workforce for digital transformation.
• The digital nursing and midwifery leader in the organisation reports to both the board level nursing leader and digital lead, ensuring a multidisciplinary leadership team approach.
• Digital midwives work in collaboration with the organisation digital nursing and midwifery leader.
• Nursing and midwifery practice is fundamental and integral to the development of the ICS system-wide digital strategy that sets out a unified vision of digitally enabled care.
• Data and digital requirements are clearly articulated in the organisations’ ICS data and digital strategy.
• Nursing and midwifery roles in all care settings, including primary, community and social care are involved in future data and digital opportunities to join up care.

What good looks like for organisations:

• Nursing and midwifery needs are included in the organisation’s digital strategy, which aligns with the ICS vision for how to achieve digitally enabled care.
• A specialist team representative of both professions with expertise in digital transformation for healthcare support the implementation of digital technologies.

Success measure 2 - Ensure smart foundations

Organisations and sectors across your ICS are supported with system-wide data that joins up care. Nursing and midwifery staff are present at all stages of developing data and digital solutions, resulting in fit-for-purpose systems that reduce the documentation burden and strengthen the organisation and wider ICS.

What good looks like for ICSs:

• Protected time for all staff within the professions are included as part of the multidisciplinary team working on the design, implementation, testing and evaluation of technology.
• Nurses and midwives collaborate to support the delivery of the ICS-wide shared care record by developing a system-wide approach for data collection and analysis. To enable this, both professions share best practice on the use of clinical digital systems across regions.
• Consistent coded and structured terminologies are implemented across the ICS to enable care to be joined up within the system.
• Nurses and midwives can see the impact of the data that they have generated has on people, supporting a system-wide culture that values robust data collection.
• Digital systems include all required clinical documentation to support effective practice.

What good looks like for organisations:

• NHS England - Towards a unified vision of nursing and midwifery documentation is used to help organisations implement record systems and policies which support nurses and midwives to produce good documentation which evidences professional decision making and care, while minimising time spent on producing those records.
• Digital clinical content that has had nursing and midwifery input approved through the existing governance structure.
• Nurses and midwives are encouraged to increase the use and expand the functionality of already adopted tools through a culture that enables safe experimentation.
• Digitally generated data from people using the organisation’s services is used to improve care and processes.

Success measure 3 - Safe practice

Consistently safe processes and systems are in place across your ICS, and its organisational boundaries, to support digitally enabled, safe and personalised care. As a result, nurses & midwives provide the best and safest care.

What good looks like for ICSs:

• Staff are trained to be knowledgeable and proactive about information security and digital clinical safety.
• Digital leaders are familiar with understanding clinical safety standards such as DCB0129 and DCB0160, as well as frameworks such as the Digital Technology Assessment Criteria (DTAC).
• Reviews are regularly performed to identify digital clinical safety incidents related to care and practice. Themes from this process are identified and shared across the ICS and on a regional and national level.
• Clinical Safety Officers (CSO) engage with nurses and midwives to ensure safe practice is considered as part of digital clinical safety.

What good looks like for organisations:

• Digital leaders are trained in digital clinical safety and use this information to play a key role in the digital clinical safety process.
• All staff have knowledge of the risks associated with data and digital solutions and how this applies in practice.
• Staff are supported to identify, escalate and address clinical risks and incidents related to digitally enabled care through the governance process in the organisation.

Success measure 4 - Support nurses and midwives

ICSs and organisations ensure the right skills and support are in place to provide digitally enabled care. As a result, teams across health and social care can build system-wide knowledge and capabilities which transform the provision of care.

What good looks like for ICSs:

• Digital leaders can access relevant training to lead digital transformation and enable safe and effective practice. For example, information governance, clinical safety, cybersecurity, leadership and change management training.
• Nurses and midwives have the digital and data literacy skills necessary to make best use of technology and data, in line with competency frameworks.
• System-wide networks share best practice and case studies in digitally enabled care from across the ICS, such as the COVID-19 Catalogue of Change.
• Utilise the NHS England Inclusive digital healthcare framework to enable and facilitate greater access to and improved experiences of healthcare, and increased adoption of digital approaches where that’s appropriate.

What good also looks like for organisations:

• The Digital Literacy Self-Assessment Diagnostic tool or an equivalent is used by nurses and midwives to support individual self-assessment and continuous.
• Regular engagement and feedback is sought to understand the successes and challenges faced when delivering digitally enabled care.
• The organisation’s digital leaders are trained with the key skills to work in a digitally enabled environment.
• Ensure procurement of systems are collaborative with the inclusion of nurses and midwives.
• When initiating, developing and updating services, utilise the NHS England Inclusive digital healthcare framework to help ensure that digital approaches and technologies are designed and implemented inclusively, and are complementary to non- digital support.

Success measure 5 - Empower people

Nurses and midwives are best placed to empower people to take an active role in their own care. ICSs and organisations ensure accessibility and digital inclusion throughout nursing and midwifery care, supporting all citizens to be part of the digital transformation journey. The ability to access personal healthcare information is key to success and nurses and midwives are best placed to enable and support citizen engagement.

What good looks like for ICSs:

• The use of national tools and services, NHS.uk,and the NHS App, along with any additional local digital services such as patient engagement portals are promoted as part of clinical practice to best support people.
• There is consistent system-wide knowledge of local healthcare record accessibility enabling people to access and contribute to their own care record.
• Nurses and midwives use new and existing systems such as patient participation groups (PPGs) and Maternity and Neonatal Voice Partnerships, where citizen voices are heard and their findings are shared, to design digitally enabled care.
• People are identified and encouraged to take part in service design, providing information to patient groups and user design forums.

What good looks like for organisations:

• Assessments to measure people’s digital literacy are incorporated into care, ensuring identification and support for those at risk of digital exclusion, whilst acknowledging those who have chosen not to use digital technology.
• Nursing and midwifery practice contribute to the organisation’s discussion about citizen digital literacy which can be used to inform care delivery.
• People are encouraged to take part in their care using the available digital technologies, such as patient engagement portals, and maternity specific apps which enable people to access and interact with their digital maternity records, facilitating decision making.

Success measure 6 - Improve care

Your ICS actively seeks out new ways data and digital solutions can improve the care delivered. An open and safe environment is created in and across organisations for nurses and midwives to lead and deliver on projects and research which support improvements in digitally enabled care.

What good looks like for ICSs:

• Nurses and midwives are provided with the information and skills to use digitally enabled care pathways, ensuring a consistent system-wide approach and involving people to choose their care delivery preferences.
• Examples of national and international innovative digitally enabled practices are identified, adapted and implemented across organisations and sectors, in partnership with social care and shared with others.
• Nurses and midwives work with academic partners and citizens to develop and implement a programme of nurse and midwife led research. This will create new evidence to support digitally enabled practice.
• A shared approach to creating a data-driven culture is developed that supports clinical practice.

What good looks like for organisations:

• Resources provided by the CNO Shared Governance: Collective Leadership programme are used to develop local programmes that improve quality outcomes using data to support accreditation.
• Nurses and midwives are part of the multidisciplinary team leading the development of evidence-based clinical decisions and data utilisation to support service improvements in the organisation.
• Opportunities within the organisation where data and digital solutions can support nurse and midwifery led improvements are identified and implemented, such as remote monitoring and virtual care in partnership with social care.

Success measure 7 - Healthy populations

Nursing and midwifery are embedded within communities and are responsive to each population’s unique health needs. Your ICS provides the system-wide access to data and digital solutions that best support the health of the population.

What good looks like for ICSs and organisations:

• The nursing and midwifery voice is included as part of population health management discussions across the ICS and in the development of data intelligence platforms.
• Nurses and midwives work closely with data analysts and data scientists to maximise insights from population health data.
• Standardised data principles such as SNOMED CT and PRSB standards are implemented across the ICS to ensure health data that accurately represents people and supports population health is collected consistently.
• Nurses, midwives and multidisciplinary leaders identify population health data gaps and advocate for their inclusion in the minimum data set.